Sacroiliitis - Diagnosis and Treatment

Sacroiliitis is a painful condition that involves inflammation of the sacroiliac joint. It is usually felt as pain in the lower back or buttock.

While it often occurs by itself, it can also be found associated with more debilitating conditions, such as ankylosing spondylitis and Reiter’s disease.

In this article, I want to present you with some key information about sacroiliitis, such as the symptoms often reported by patients, and how it is commonly diagnosed and treated. While this is not an in-depth article, I hope is gives you a basic understanding of the condition.

The Sacroiliac Joint

The sacroiliac joint is formed by the joining of the sacrum and the ilium on both sides of the pelvis.

The primary role of the sacroiliac joints is to transfer weight from the upper body and spine to the pelvis and legs. To fulfil this role, the joints are reinforced with very thick, strong ligaments.

For many years, the sacroiliac joint was believed to be totally fixed.

In recent times, research has revealed that there is a small amount of movement at these joints and that pain originating from this area can be caused by abnormal movement or alignment of the sacroiliac joints.

What Is Sacroiliitis?

As mentioned above, sacroiliitis is inflammation of the sacroiliac joint.

There are many factors that can contribute to the inflammation, some of these factors are:

Movement dysfunction. Abnormal alignment and movement of the sacroiliac joints can lead to pain and inflammation.

Pregnancy. During pregnancy hormones are released to soften the ligaments around the pelvis. This can result in an increased amount of movement at the sacroiliac joints. Combine this with the added weight of a pregnancy, and you get increased stress on the joints, which can then lead to pain and inflammation.

Inflammatory joint disorders. This condition can occur in combination with a number of inflammatory joint disorders. Some of these disorders are ankylosing spondylitis, Reiter’s disease and psoriatic arthritis. In some cases, the presence of sacroiliitis can lead to further investigations that reveal these more debilitating conditions.

Osteoarthritis. Normal wear and tear that occurs at any joint in the body can cause osteoarthritis. As the sacroiliac joints are weight-bearing joints, they can also become worn and show signs of osteoarthritis.

Trauma. Forceful injury, such as from a car accident, can cause direct damage to the joints.

Infection. Infection of the sacroiliac joints can also cause inflammation, however, this is very rare.

Symptoms

The most common symptom reported by patients with this condition is pain. The pain is often felt very low in the back, on one side or both. The pain can also radiate to the buttock, groin and front of the thigh. It is also common for the pain to be worse at night and be associated with back stiffness.

Diagnosis

While physical examination can aid in a preliminary diagnosis of this condition, definitive diagnosis is usually achieved by using scans such and x-ray, CT scans and MRI scans. In well developed cases of the condition, these scans will show damage to the joint surfaces.

Where joint infection is suspected, blood tests are used to confirm the diagnosis.

Treatment

Treatment of sacroiliitis is dependant on the cause of the condition as determined by the treating doctor or therapist.

The following are treatment options that are available according to the cause of sacroiliitis.

Movement Dysfunction

If the cause of the condition is believed to be due to misalignment of the sacroiliac joints, then treatment usually involves:

Taking medications to control the pain and inflammation.

Correcting the misalignment with manual joint techniques, such as mobilisation and/or manipulation.

Soft tissue techniques, such as massage, to relieve muscle spasm around the hip and buttock region.

Teaching exercises to ensure that muscle strength and flexibility are balanced around the hip and lower back.

Pregnancy

Sacroiliac related pain experienced during pregnancy can be treated using the following options:

Soft tissue massage to the muscles of the hip and lower back.

Gentle manual joint techniques, such as mobilisation, performed by a physiotherapist.

Using strapping tape to help support the lower back and sacroiliac joints.

Teaching exercises aimed at strengthening the hip and lower back muscles and ensuring adequate flexibility of related muscles.

Inflammatory Joint Disorders

If the sacroiliitis is associated with conditions such as ankylosing spondylitis, then treatment often includes:

Taking medications that have been found to be effective in ankylosing spondylitis, such as disease modifying antirheumatic drugs (DMARDs) and TNF inhibitors.

Physiotherapy exercises aimed at maintaining flexibility and muscle strength around the lower back and hip joints.

Postural exercises are also of great benefit.

With proper diagnosis and treatment, most cases of sacroiliitis will improve within a few short weeks. Cases associated with inflammatory disorders, such as ankylosing spondylitis, will take longer, having to let the disease process take its course.

If you believe that you have sacroiliitis, my advice is to see a qualified health practitioner who can properly assess your back and give you the appropriate treatment. This will ensure that you will recover as quickly as possible.

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